Six to eight percent of all pregnancies are complicated by gestational hypertension or pre-eclampsia.1,2 Although outcome in most cases is good, hypertensive diseases remain a major cause of morbidity and mortality for both mother and child.3 Moreover, the care for women with hypertensive disease in pregnancy imposes a substantial economic burden.
Most hypertensive diseases occur at or near term.4 Because evidence on the choice between induction of labour and expectant monitoring for women with gestational hypertension or mild pre-eclampsia at term is lacking, we recently performed a randomised clinical trial on that subject:5,6 the Hypertension and Pre-eclampsia Intervention Trial At Term (HYPITAT, number ISRCTN08132825). Induction of labour resulted in significantly fewer women with progression to severe disease and the caesarean section rate was lower, albeit not significantly. Apart from these clinical outcomes, knowledge on the cost is also of importance, to decide whether induction should be applied or not. At present, evidence on costs and cost-effectiveness of management of women with gestational hypertension or pre-eclampsia at term is limited.
This study reports the results of the economic evaluation that we performed alongside the HYPITAT trial. We performed a cost-effectiveness analysis comparing induction of labour with expectant monitoring in pregnancies at high risk because of hypertensive disorders beyond 36 weeks of gestation.